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CST Interview > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Bicep reflex

A

C5/C6

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2
Q

Tricep reflex

A

C6/C7

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3
Q

Abdominal reflex

A

T8 - T12

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4
Q

Knee reflex

A

L3/L4

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5
Q

Ankle reflex

A

S1/S2

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6
Q

Brachioradialis reflex

A

C5/C6

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7
Q

Grading of reflexes

A

0 = absent

1 = hypoactive

2 = normal

3 = hyperactive, no clonus

4 = hyperactive + clonus

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8
Q

Factors affecting fracture healing

A

Local trauma: soft tissue injury, tissue loss, sort tissue interposition, neurovascular injury, open fractures

Inadequate reduction and immobilisation

Infection

Location: metaphysics vs diaphysis

Metabolic

Age, NSAIDs, T2DM, Smoking

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9
Q

Perkin’s rule of fracture healing

A

Fracture of cancellous bone - metaphysical approx 6 weeks

Fracture of cortical bone - diaphysial approx 12 weeks

Fracture of tibia approx 24 weeks

Children, age plus 1 in weeks

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10
Q

Definition of delayed union

A

1.5x times normal fracture time

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11
Q

Definition of non-union

A

Failure of fracture at 2x expected healing time

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12
Q

Classification of non-union

A

Hypertrophic non-union
=excess mobility and stress
-large callus
-managed by fixation

Atrophic non-union
=poor blood supply

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13
Q

Osteomalacia

A

Reduced mineralisation of osteoid

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14
Q

Osteoporosis

A

Low bone mineral density
Low bone mass

Normal mineralisation

Prone to fractures

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15
Q

AO management of fracture principles

A

Fracture reduction to restore anatomical alignment

Fixation or stabilisation across fracture

Preservation of blood supply and soft tissues, utilisation of gentle reduction techniques

Early and safe mobilisation

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16
Q

Complications of plaster paris

A

Pressure areas

Venous thromboembolism

Loosening

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17
Q

Indications for internal fixation

A

Intra-articular fractures

Unstable fractures

Neurovascular damage

Polytrauma

Elderly in which bedrest would result in decline

Long bone fractures

Pathological fractures

Failed conservative stabilisation techniques

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18
Q

Management of factures of shaft of ulna and radius

A

Mechanism: fall on out-stretched hand

Undisplaced = above elbow cast
Displaced = open reduction and compressible plate fixation

Monteggia: proximal
Galeazzia: distal
Fracture dislocations are indication for open reduction and plating

FU x-ray at week 1 and week 2 to ensure reduction

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19
Q

Gartland Classification

A

Supracondylar fractures

Type I: undsiplaced

Type II: angulated or displaced but posterior cortex intact acting as a hinge

Type III: complete displacement

Type IV: completely displaced and unstable in flexion and extension

Mx: III or IV –> orthopaedic emergency and require K-wire fixation

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20
Q

Management of supracondylar fractures

A

Gartland classification II-IV are fixed with medial and lateral K-wires
AND above elbow casting

Gartland I: collar and cuff

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21
Q

Complications of supracondylar fractures

A

Vascular compromise from compression of brachial artery or vascular spasm
If transected - need interposition vein graft

Ischaemic contracture: Volkamn’s

  • contraction and fibrosis of forearm
  • avoided by early intervention

Neuropraxis

  • radial nerve
  • anterior interosseous nerve, branch of median nerve

Mal-union

  • gun-stock deformity
  • recurvatam more common in casting
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22
Q

Epicondyle fracture of humerus

A

Avulsion-type injuries of apophysis
-high associations with elbow dislocations

Fragment can be trapped in elbow joint
-indication for open fixation

Management: long-arm casting, unless trapped body

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23
Q

Lateral condyle fractures of the humerus

A

Milcon classification
Type I: # of growth centre capitulum (Salter Harris IV)
Type II: # medial to growth centre and can involve trochlea (Salter Harris II)

Mx: fixation with K-wires or cannulated screws
-if not will be displaced by wrist extensors

24
Q

Assessment of the hand

A

Motor innervation

  • OK sign = median nerve
  • Cross fingers = ulnar nerve
  • Extend wrist = radial nerve

Sensory innervation

  • Webbing between thumb and index finger on PALMAR surface = median nerve
  • Between distal little finger and distal ring finger on palmar/dorsal surface = ulnar nerve
  • Webbing between thumb and index finger on DORSAL surface = radial nerve
25
Q

Testing radial innervation to the hand

A

Motor = wrist extension

Sensory = Webbing between thumb and index finger on DORSAL surface of the hand

26
Q

Testing median innervation to the hand

A

Motor = OK sign

Sensory = Webbing between thumb and index finger on the PALMAR surface of the hand

27
Q

Testing ulnar innervation to the hand

A

Motor = cross index and middle finger

Sensory = distal little and ring finger

28
Q

Complications of supracondylar fractures

A

Early

  • damage to brachial artery
  • damage to radial nerve (and median nerve)
  • damage to brachial vein
  • infection
  • haemorrhage

Intermediate

  • compartment syndrome
  • infection
  • secondary haemorrhage

Late

  • Volkman ischaemic contracture
  • Sudek’s atrophy
  • Mal-union –> deformity
  • Non-union
29
Q

Definition of Mal-union

A

Healing of a fracture in an abnormal position leading to shortening or deformity

30
Q

Definition of Non-union

A

Arrest in fracture healing process

31
Q

Gartland classification of Supracondylar Fractures

A

Type 1 = undisplayed or minimally displaced

1a: non-displased in two views
1b: minimal displacement, medial cortical buckling

Type 2 = displaced but with INTACT cortex

2a: posterior angulation with intact posterior cortex
2b: rotatory displacement / straight displacement

Type 3 = completely displaced

3a: no cortical contact
3b: soft-tissue interposition

32
Q

Type 1 Gartland

A

Type 1 = undisplayed or minimally displaced

1a: non-displased in two views
1b: minimal displacement, medial cortical buckling

33
Q

Type 2 Gartland

A

Type 2 = displaced but with INTACT cortex

2a: posterior angulation with intact posterior cortex
2b: rotatory displacement / straight displacement

34
Q

Type 3 Gartland

A

Type 3 = completely displaced

3a: no cortical contact
3b: soft-tissue interposition

35
Q

Holstein-Lewis Fracture

A

Fracture of the distal third of the humerus resulting in entrapment of the radial nerve.

36
Q

Management of humeral shaft fractures

A

Sugar tongue casting for 1-2 weeks

Then functional brace for up to 3 months

Regular clinic follow-up

37
Q

Presentation of slipper upper femoral epiphysis

A

Obese children

M: 12 - 15 years
F: 10 - 13 years

Waddling gait

Hip/knee pain

Reduced internal rotation

May be held in external rotation and shorten

20% are bilateral

38
Q

Investigations for a slipper upper femoral epiphysis

A

Full joint examination of hip and knee

AP plain radiograph and lateral / frog’s leg pelvis veiws

39
Q

Management of slipper upper femoral epiphysis

A

Acute: reduction and cannulated screw fixation

Chronic: no reduction, cannulated screw fixation in-situ

40
Q

Classification of slipper upper femoral epiphysis

A

Acute: <3 weeks

Chronic >3 weeks

Stable: able to WB

Unstable: unable to WB

41
Q

Complications of slipper upper femoral epiphysis

A

Avascular necrosis

Chondrolysis

Osteoarthritis

Malunion, deformity

Iatrogenic: subtrochanteric fracture if pinned too low

42
Q

Definition of slipper upper femoral epiphysis

A

Displacement of epiphysis inferno-posteriorly through the growth plate

43
Q

Risk factors for slipper upper femoral epiphysis

A

BMI

Rapid growth

Hypothyroidism

Renal ricketts

Pituitary deficiency

Growth hormone deficiency

Left > right

Male > female

44
Q

Diagnostic examination finding of SUFE

A

When hip is flexed –> external rotation

limited ABduction
Shortended, externally rotated

45
Q

X-ray findings of SUFE

A

Widening of physics = pre-slip

Klein’s line: line from superior femoral neck should direct head, if it doesn’t = slip

46
Q

Presentation of hip dislocation

A

Post hip replacement

Pain

Reduced range of movement

Internally rotated

47
Q

Hip dislocation post arthroplasty

A

1-7% of hip replacements

Occurs within 3 months

Recurrence likely

48
Q

Post arthroplasty films

A

Check no fracture in native bone, ruling out periprosthetic fracture

Check for changes in angulation that may suggest loosening

Check femoral component is in acetabulum

49
Q

Management of hip dislocation

A

Needs relocation

Under sedation or GA

50
Q

Risk factors for hip dislocation

A

Patient factors

  • female > M 2:1
  • weak hip musculature
  • age
  • obesity
  • alcohol
  • congenital developmental dysplasia of the hip

Surgical approach

  • posterior approach much higher risk
  • revision surgery
  • capsular excision
51
Q

Posterior vs lateral approach to hip

A

Posterior approach

  • higher rate of dislocation
  • lower sciatic nerve injury

Lateral approach

  • less likely to dislocate
  • higher risk of sciatic nerve injury
  • more likely to bleed
52
Q

4 compartments of the leg

A

Anterior compartment

Lateral compartment

Superficial posterior compartment

Deep posterior compartment

53
Q

Diagnostic criteria for compartment syndrome

A

= clinical diagnosis

> 30mmHg compartment pressure –> highly suggestive

> 40mmHg compartment pressure or <30mmHg of diastolic BP = diagnostic

54
Q

Definition of compartment syndrome

A

Increased pressure in an osteofascial compartment leading to venous and lymphatic occlusion which progressed to limb threatening ischaemia

55
Q

Management of compartment syndrome

A

Cast and dressings off

Elevate limb

Analgesia

NBM

IV fluids, reduce rhabdomyolysis

Bloods inc group and save

Reg on-call

CEPOD

Fasciotomy

56
Q

Differential diagnosis of an acutely painful limb

A

Acute limb ischaemia

DVT

Compartment syndrome

Missed fracture

CST Interview (11 decks)

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